Posted 3 months ago
Medical Officer - Health Claims
Kavachsure General Insurance
- Compensation
- Not disclosed
- Experience
- 2–5 yrs
- Workplace
- On-site, Mumbai
- Engagement
- Full-time
About the role
Kavachsure General Insurance underwrites health, motor and commercial lines with over four million policyholders and a cashless network of 9,000 hospitals. Our Mumbai claims hub is hiring Medical Officers to adjudicate health claims. You will review cashless pre-authorisations and reimbursement files, assess medical necessity against policy terms, identify billing anomalies, and interact with hospital insurance desks on queries. BAMS, BHMS or MBBS qualification with registration is required; prior TPA or insurer claims experience is preferred. The role offers structured exposure to IRDAI claim regulations and a clear path to senior adjudication and audit roles.
What you will own
- Adjudicate cashless pre-authorisation requests within committed turnaround times
- Assess reimbursement claims for medical necessity and policy admissibility
- Identify inflated billing, unbundling and non-payable items in hospital bills
- Raise and close queries with hospital insurance desks professionally
- Document decision rationale completely for audit and grievance review
- Flag suspected fraud cases to the investigation team
Qualification
Graduate
Skills
- Microsoft Excel
- Data Analysis
- Customer Service
- Communication Skills
Kavachsure General Insurance
Insurance · 501-1000 employees · Gurugram
Kavachsure General Insurance underwrites motor, health and small-commercial policies distributed through agents, brokers and its direct-to-consumer app. The head office is in Cyber City, Gurugram, with regional offices in Mumbai, Chennai and Kolkata. Claims automation is the current technology priority: the company processes a majority of motor claims through app-based surveys and is expanding its in-house engineering team to reduce dependence on vendors. Actuarial, underwriting and claims roles have defined technical career ladders, and the company funds III and actuarial examination fees for employees.
Company website